Diagnosis of cholelithiasis in children
Last reviewed: 23.04.2024
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Physical examination
For the diagnosis of cholelithiasis in children, careful collection of anamnesis is important. Body temperature is usually unchanged; the diagnostic value of "pinpoint" pain symptoms (Jonash, Ridel, Lyakhovitsky, Kharitonov, etc.) in children is low. Rarely are symptoms of Grekov-Ortner, Kera, Mussie. Hepatomegaly for children with cholelithiasis is not characteristic. Moderate protrusion of the liver (1-2 cm) from under the edge of the rib arc on the right sredneklyuchichnoy line is possible with a violation of the outflow of bile.
Laboratory research
First of all, serum enzymes - indicators of the cholestatic syndrome (hepatic fraction of alkaline phosphatase, y-glutamyltranspeptidase, leucin aminopeptidase, etc.) are investigated. Significantly increased blood levels of triglycerides; the concentration of total lipids is reduced. The simultaneous increase in the level of triglycerides, unesterified fatty acids and phospholipids indicates a marked disturbance in the metabolism of bile acids.
Instrumental research
The most informative is ultrasound; The detection of gallstones in diseased children occurs in 95-99%.
X-ray methods, including cholegraphy and CT scan, are poorly informative in the diagnosis of cholelithiasis, since they can detect only calcified gallstones.
Magnetic resonance cholangiopancreatography in children with cholelithiasis is used to detect concrements of bile ducts, including intrahepatic bile ducts, as well as bile duct anomalies. On diagnostic significance the method is not inferior to endoscopic retrograde cholangiopancreatography.
For the diagnosis of the "disconnected gallbladder" scintigraphy of bile ducts with Tc-substituted imidodiacetic acids is used. The absence of a mark on the scan in the gallbladder 90 minutes after intravenous administration of the drug indicates the obstruction of the cystic duct. The method also allows to diagnose violations of the concentration and contractility of the gallbladder, assess the patency of extrahepatic biliary ducts, dysfunction of sphincters Oddi and Lutkens.
Differential diagnostics
Gallstone disease is differentiated with esophagitis, gastritis, gastroduodenitis, chronic pancreatitis, chronic duodenal obstruction. Particular difficulties are the cases of hospitalization of children with a picture of "acute abdomen." In this situation, cholelithiasis is differentiated with acute appendicitis, infringement of the hernia of the esophageal opening of the diaphragm, peptic ulcer of the stomach and duodenum, intestinal disease, intestinal obstruction, and in girls with gynecological diseases (adnexitis, torsion of ovarian cysts, etc.). Similar symptoms are possible with diseases of the urinary system - pyelonephritis, cystitis, urolithiasis, etc.
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